Practice Management Scope of Services

Transcription

1 Practice Management Scope of Services

2 TABLE OF CONTENTS PRACTICE ENTITY SERVICES... 3 FINANCIAL SERVICES... 4 THIRD-PARTY BILLING & COLLECTION VENDOR PARTNERING... 6 IT SERVICES... 7 HUMAN RESOURCE SERVICES PRACTICE OPERATIONS MANAGEMENT SERVICES PROVIDER SCHEDULING SERVICES PROVIDER RECRUITING SERVICES CREDENTIALING SERVICES RISK & LITIGATION MANAGEMENT SERVICES STAKEHOLDER SATISFACTION ASSESSMENT Page 2 of 17

3 Practice Entity Services Practice Financial Responsibilities 1. Develop practice feasibility analysis 2. Develop practice forecast Structure 1. Assist practice with alternatives for entity structure based on group philosophy 2. Work with practice to produce draft shareholder/operating/buy back agreements 3. Manage independent legal counsel to finalize ownership agreements Practice Governance 1. Assist practice in the formation of a governance structure to manage the practices business affairs 2. Facilitate monthly management meetings Ownership 1. Assist group in development of ownership track for new owners 2. Assist group in development of financial impact of new owners 3. Assist group in the development of member buy out plans Practice Development Responsibilities 1. Assist practice with strategic planning process 2. Assist practice with mission/vision development process 3. Assist practice with implementation of strategic plan Practice Financing 1. Assist practice with financing options 2. Work with multiple lenders to secure Ramp up financing 3. Negotiate loan terms with financing institutions Page 3 of 17

4 Financial Services Accounts Payable Services 1. Prepare checks to pay all practice expenses 2. Track, analyze & report practice expenses 3. Maintain expense receipts & audit trail 4. Manage authorization & payment of expenses 5. Manage vendor selection & financial relationships Banking Relationship 1. Assist group with selection of suitable banking partner 2. Work with banker to arrange for financing for ramp-up receivables 3. Negotiate loan agreements with bank including owner guarantees 4. Lock box operation oversight 5. Credit card equipment, connectivity & collections management Cash Collection Management 1. Institute & oversee cash collection & deposit management system 2. Reconcile cash collections with hospital and or billing company 3. Maintain daily deposit log 4. Optimize use of line-of-credit and/or interest earning account to minimize carrying costs Financial Reporting 1. Compile, analyze & report daily & monthly patient visit volumes by provider, location & group 2. Compile, analyze & report collections by provider, location & group 3. Compile, analyze & report on a monthly basis in accordance with generally accepted accounting principles (GAAP): Income statement (P&L) Statement of cash flows Statement of financial condition (balance sheet) Budget statement Income Taxes 1. Advise on year-end tax planning alternatives coordinate tax return preparation 2. Tax preparer with tax basis financial statements Patient Refund Services 1. Review appropriateness of patient refund payments prepared or requested by billing company 2. Prepare patient refund checks 3. Perform state required escheat payment activities 4. Prepare and file state escheat returns Page 4 of 17

5 Provider Compensation 1. Develop and implement incentive based compensation plan 2. Calculate provider compensation monthly in accordance with plan 3. Analyze productivity by shift type 4. Prepare & coordinate issuance of bi-weekly or monthly payroll checks 5. Prepare and coordinate direct deposit checks, payroll deductions & garnishments 6. Prepare and coordinate 401(k) withholding & funds transfer 7. Prepare state and federal payroll tax returns including W-2s and 1099s Retirement Plans 1. Assist in developing retirement plan that matches group s philosophy 2. Assist in ongoing analysis of retirement plan objectives & costs 3. Prepare company retirement plan accruals monthly Page 5 of 17

6 Third-Party Billing & Collection Vendor Partnering 1. Coordinate Chart Audit with prospective billing companies 2. Compile and analyze Chart Audit results 3. Assist in the evaluation and selection of billing company 4. Negotiate contract with billing company 5. Assist in the evaluation and selection of collection agency 6. Negotiate contract with collection agency 7. Evaluate and monitor billing company s relationship with all MCP s in the marketplace 8. Evaluate and monitor billing company s relationship billing company s relationship 9. Oversee terms of all MCP contracts on behalf of group providers 10. Assist in establishing and periodically updating practice fee schedule & charge designation sheets 11. Secure billing data electronically in monthly downloads to web based data warehouse to: Facilitate incentive based compensation calculation Benchmarking all aspects of billing vendor performance Monitor coding by: o E&M distribution benchmarking by age group by provider o Non E&M CPT code utilization benchmarking by provider Monitor collection proficiency of billing company by benchmarking by payor group Chart reconciliation through chart reconciliation system (CRS) 12. Secure Collection Agency data electronically in monthly downloads to web based data warehouse to: Benchmarking the Billing Vendor and Collection Agency performance by normalizing the Collection Agency performance by: o Benchmarking collections per placements to agency by payor group o Benchmarking percentage of overall collections realized from the Collection Agency by payor group 13. Coordinate, compile and analyze independent coding audit(s) on a periodic basis 14. Assist provider documentation & coding education 15. Review appropriateness of patient refund payments prepared or requested by billing company 16. Conduct site visit to billing company Page 6 of 17

7 IT Services 1. Provide access to client web portal 2. Create provider dashboards accessible via web portal 3. Provide web based data warehouse and query tool specific to group. Metrics may include: Productivity E&M Distribution Patient Satisfaction 4. Provide access to and implement any of following portal modules upon request and data availability: Chart Capture o Chart Reconciliation System (CRS) o Chart Deficiency Tracking o Coding Audits o Returned Chart Tracking Communication o Feedback Management o Discussion Forums o ED Event Tracking o Dashboard Messaging Contacts o AAEM PG Group Contacts o Group Directory o Disaster Plan Director Reports o Productivity o E&M Distribution o Patient Satisfaction o Deficiency Reporting o Negative Patient Satisfaction o Shift Equity Report o WebQI Datamart o Vacation Hours Report o Partner Library Human Resources o My Pay Stubs o My CME o My FDA o My Vacation Hours o My Retirement Plan o My Expense Tracker o CME Balances o Expense Management Page 7 of 17

8 Marketing o Lead Tracking o Marketing Materials Management Mentoring o Mentor Module o Checklists / Evaluations Patient Satisfaction o Datamart o Survey Questions o Patient Comments o Negative Survey Report o Negative Percentage Report o Completed Survey Report Quality Improvement o Process Improvement Chart Mgmt o Peer Review Tracking o Variances o WebQI (On-Line Chart Review) 1. Review Template Library 2. Customized Templates MLP Issues o MLP Education Module o MLP Policies Recruiting o Impact Engine Campaigns o Sendouts Hiring Manager Module Resource Libraries o AAEM PG Library o Group Library o Partner Library o Frequent Links Risk Management o Claims Repository Scheduling o Tangier o Shift Call-In Tracking 360 Surveys o EDSurveys.net Physician Chart Scanning Page 8 of 17

9 5. Assist in development of ad hoc ED related applications. 6. Serve as advisor to practice regarding outsource acquisition of hardware, software and maintenance vendors including EDIS / EMR systems. 7. Consult regarding practice web page technical and content issues. Page 9 of 17

10 IT Analytic Services 1. Monthly statistical alerts via 2. Scorecards Group Campus Provider 3. Monthly report packages as requested and based on data availability Productivity E&M Distribution Patient Satisfaction o AAEM PG Survey o Hospital Survey o Complaints Documentation Deficiencies Efficiency Metrics o Length of Stay o Arrival to Room o Room to MD o MD to Disposition Patient Composition o Age o Disposition o Diagnostic Groupings o Financial Class Peer Comparisons Utilization 360 Surveys Quality o WebQI o Variances 4. Evaluation of appropriate coverage models 5. In depth utilization studies 6. Advanced statistical studies Patient Satisfaction o Root Cause Analysis o Trending Volume o Profile Analysis o Trending o Cachement Area Studies Page 10 of 17

11 Human Resource Services 1. Benefits Management for Physician: Enrollment Changes CME allowance management Problem resolution Payroll deduction management Process monthly benefit bills Medical reimbursement accounts Bimonthly COBRA notification 401(k) contribution administration 2. Assist in orientation of new employees 3. Maintain employee personnel files & database 4. Manage verification of employment & salary issues 5. Process insurance and other claims: Unemployment Short-term disability Workers compensation Family Medical Leave 6. Reporting, internal & external: Management Reports State Reports Turnover Reports 7. Legal & Compliance: Write/maintain Policies & Procedures Manual Write/maintain Employee Handbook Write/periodically revise job descriptions/employment contracts Employer-employee legal consultation 8. Manage OSHA, CLIA, CMS, HIPAA & all other compliance issues 9. Assist group management in hiring, terminations, employee relations 10. Organization chart preparation & maintenance 11. Manage insurance vendor selection & relationship: Benefits Health Property Workers Compensation Page 11 of 17

12 Practice Operations Management Services Comprehensive group operations management: Chart Reconciliation 1. Oversee & manage chart capture process through Chart Reconciliation System (CRS) Practice Management Responsibilities 1. Oversee all aspects of day to day practice management 2. Clerical support for management team 3. Back-up day to day practice management with onsite presence as needed 4. Coordinate practice marketing & promotion programs Practice Staffing Responsibilities 1. Assist practice with possible staffing alternatives based on census by acuity by hour of day 2. Assist practice with provider hire/fire decision support 3. Assist providers with recruiting & scheduling initiatives 4. Oversee on-site personnel performance 5. Monitor practice operational efficiency & suggest improvements Practice Complaint Management 1. Assist provider(s) in researching & resolving all patient complaints 2. Assist provider(s) in researching & resolving all MCP complaints Page 12 of 17

13 Provider Scheduling Services 1. Assist group in creating a formalized time-off request and holiday preference that suits the groups requirements 2. Manage all provider scheduling as directed by the group that may consist of: Request and receive schedule preference forms Prepare & distribute preliminary schedules to group Prepare & distribute final schedules once approved by group Maintain a master schedule database reflecting all initial schedules, schedule changes and final schedules throughout each month Maintain 24/7 on-call scheduling back-up for scheduling problems including shift no-shows and peak load staffing needs 3. Assist group in creating a call system in place to serve as a scheduling resource 4. Manage disaster plan implementation process 5. Publish schedules and time off requests will be available on our secured website 6. Render monthly, quarterly, and annual scheduling reports by individual provider, location and group equity log based on group defined standards (e.g., # or % of weekends, % of nights, % of holidays) 7. Assist group to resolve individual group provider schedule disputes Page 13 of 17

14 Provider Recruiting Services 1. Maintain a continuous recruiting presence in the EM recruiting marketplace through direct mail, advertisements, professional & tradeshow attendance, etc. 2. Receive and review all candidate CVs and application materials 3. Pre-screen and qualify candidates based on group defined criteria 4. Develop recruiting advertisements 5. Continuous representation on AAEM PG website 6. Assist potential candidates in the completion of their application packets 7. Schedule all applicant interviews & manage travel/lodging arrangements 8. Negotiate and manage all contracts with recruiting agencies if the group elects to use these 9. Be knowledgeable of the group s provider contract/employment agreement 10. Coordinates recruiting with scheduling & credentialing Page 14 of 17

15 Credentialing Services New Hire Provider 1. Receive all group application paperwork 2. Facilitate prior acts malpractice insurance coverage 3. Coordinate new malpractice insurance application & coverage 4. Coordinate license change of address 5. Assist in scheduling orientation as indicated 6. Manage hospital privilege applications 7. Manage MCP applications 8. Manage expired provider documents 9. Enter/maintain credentials in PINT database 10. Generate weekly credentialing and enrollment report Existing Provider 1. Manage hospital reappointments 2. Manage MCP re-credentialing 3. Manage expired provider documents 4. Manage MLP state filings 5. Maintain provider credential files 6. Manage all provider numbers 7. Generate weekly credentialing report for reappointments 8. Support group operations managers 9. Support billing & collection vendors 10. CME tracking & alerting Page 15 of 17

16 Risk & Litigation Management Services Manage EM practice malpractice liability insurance coverage: 1. Facilitate new-hire provider prior acts coverage 2. Coordinate liability insurance provider search & rates/terms comparison 3. Assist providers in annual malpractice liability insurance renegotiation 4. Assist providers in malpractice liability insurance application completion 5. Assist providers in preparing incident & open claims statements for malpractice liability applications 6. Assist providers in preparing incident & open claims statements for hospital & MCP credentialing/recredentialing 7. Provide insurance coverage binders as requested by hospitals, managed care plans, etc. 8. Clarify issues of specific activities coverage (medical direction, EMS, etc.) Coordinate provider malpractice liability claim defense: 1. Receive incident reports & assist with response 2. Notify carrier as indicated 3. Receive subpoenas 4. Notify carrier 5. Create & maintain case files 6. Create & maintain case file database 7. Obtain, collate & review patient case records 8. Coordinate provider, carrier, attorneys & third-party administrators 9. Assist provider & group with interrogatories & requests for production 10. Attend trials / mediations, as required Conduct ongoing risk management & risk reduction program: 1. Periodic audit of practice risk management measures & potential problem areas 2. Assist in the development & dissemination of risk management policies & procedures 3. Coordinate risk management in-service & education as directed by group 4. Monitor & report chart review performances through data warehouse Health Law Issues 1. Assist health care practitioners and client hospitals with education and/or consulting services in EMTALA and other health law and compliance issues Page 16 of 17

17 Stakeholder Satisfaction Assessment Patient Satisfaction Assessment 1. Conduct monthly patient satisfaction surveys as follows: Randomly selected cases called monthly in order to secure 20 responses per provider Create, maintain & update as necessary a telephone satisfaction survey instrument with scripted questions and standardized responses Contact patient or patient representative to complete survey instrument Coordinate intervention in any patient dissatisfaction problems that come to light as a result of above 2. Tabulate & retain all satisfaction survey results in data warehouse 3. Report & trend all satisfaction results on a monthly & annual summary basis 4. Concordance analysis of group results with hospital s surveying company 5. Coordinate patient assessment scores with incentive compensation plan as determined by group Medical Staff Survey 1. Assist in the development and circulation of an annual survey to the Medical Staff 2. Tabulate & retain all survey results in data warehouse 3. Report & trend all survey results on a detailed and summary basis Administrators Survey 1. Assist in the development and circulation of an annual survey to Administrators that interact with ED 2. Tabulate & retain all survey results in data warehouse 3. Report & trend all survey results on a detailed and summary basis Emergency Department Survey 1. Assist in the development and circulation of an semi-annual survey to the staff working in the emergency department 2. Tabulate & retain all survey results in data warehouse 3. Report & trend all survey results on a detailed and summary basis ED Clinical Peer Survey 1. Assist in the development and circulation of an semi-annual survey to fellow clinicians working in the emergency department 2. Tabulate & retain all survey results in data warehouse 3. Report & trend all survey results on a detailed and summary basis Page 17 of 17